infliximab

What is infliximab?

Infliximab reduces the effects of a substance in the body that can cause inflammation.

Infliximab is used to treat rheumatoid arthritis, psoriatic arthritis, ulcerative colitis, Crohn's disease, and ankylosing spondylitis. Infliximab is also used to treat severe or disabling plaque psoriasis (raised, silvery flaking of the skin).

Infliximab is often used when other medicines have not been effective.

Infliximab may also be used for purposes not listed in this medication guide.

What is the most important information I should know about infliximab?

You should not use infliximab if you are also being treated with anakinra (Kineret) or abatacept (Orencia).

Before you start treatment with infliximab, your doctor may perform tests to make sure you do not have tuberculosis or other infections.

Using infliximab may increase your risk of developing certain types of cancer, including a rare fast-growing type of lymphoma that can be fatal. This risk is higher in teenagers and young adults using infliximab with other medicines to treat Crohn's disease or ulcerative colitis. Ask your doctor about your specific risk.

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Infliximab can lower blood cells that help your body fight infections and help your blood to clot. This can make it easier for you to bleed from an injury or get sick from being around others who are ill. Serious and sometimes fatal infections may occur during treatment with infliximab. Call your doctor right away if you have signs of infection such as: fever, chills, flu symptoms, or pain, warmth, or redness of your skin.

What should I discuss with my healthcare provider before using infliximab?

You should not use infliximab if you are allergic to it, or if you are also being treated with anakinra (Kineret) or abatacept (Orencia).

Some people using infliximab have developed a rare fast-growing type of lymphoma (cancer). This condition affects the liver, spleen, and bone marrow, and it can be fatal. This has occurred mainly in teenagers and young adults using infliximab with other medicines to treat Crohn's disease or ulcerative colitis.

However, people with autoimmune disorders (including rheumatoid arthritis, Crohn's disease, ankylosing spondylitis, and psoriasis) may have a higher risk of lymphoma. Talk to your doctor about your individual risk.

Using infliximab may increase your risk of developing other types of cancer, including skin cancer. Ask your doctor about your specific risk.

Tell your doctor if you have ever had tuberculosis, if anyone in your household has tuberculosis, or if you have recently traveled to an area where certain infections are common (Ohio River Valley, Mississippi River Valley, and the Southwest).

To make sure infliximab is safe for you, tell your doctor if you have:

severe heart failure, or other heart problems;

an active or recent infection, open sores or skin wounds;

diabetes;

liver disease (especially hepatitis B);

epilepsy or other seizure disorder;

chronic obstructive pulmonary disease (COPD);

a history of cancer;

a weak immune system;

numbness or tingling anywhere in your body;

a disease that affects the nerves or muscles, such as multiple sclerosis or Guillain-Barre syndrome;

if you have recently been vaccinated with BCG (Bacille Calmette-Guérin); or

if you are scheduled to receive any vaccines.

It is not known whether infliximab will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

It is not known whether infliximab passes into breast milk. You should not breast-feed while you are receiving infliximab.

Infliximab is not for use in children younger than 6 years old.

How should I use infliximab?

Before you start treatment with infliximab, your doctor may perform tests to make sure you do not have tuberculosis or other infections. Some infections are more likely to occur in certain areas of the world. Tell your doctor where you live and where you have recently traveled or plan to travel to during treatment.

Infliximab is injected into a vein through an IV. A healthcare provider will give you this injection. You may be watched closely after receiving infliximab, to make sure the medicine has not caused any serious side effects.

While using infliximab, you may need frequent blood tests.

Infliximab can lower blood cells that help your body fight infections and help your blood to clot. This can make it easier for you to bleed from an injury or get sick from being around others who are ill. Serious and sometimes fatal infections may occur during treatment with infliximab. Call your doctor right away if you have signs of infection such as: fever, chills, flu symptoms, or pain, warmth, or redness of your skin.

If you need surgery, tell the surgeon ahead of time that you are using infliximab.

If you have ever had hepatitis B, infliximab can cause this condition to come back or get worse. You will need frequent blood tests to check your liver function during treatment and for several months after you stop using this medicine.

What happens if I miss a dose?

Call your doctor for instructions if you miss an appointment for your infliximab injection.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while using infliximab?

Avoid activities that may increase your risk of bleeding injury.

Do not receive a "live" vaccine while using infliximab. The vaccine may not work as well during this time, and may not fully protect you from disease. Live vaccines include measles, mumps, rubella (MMR), polio, rotavirus, typhoid, yellow fever, varicella (chickenpox), zoster (shingles), and nasal flu (influenza) vaccine.

Make sure your child is current on all vaccines before he or she starts treatment with infliximab.

Infliximab side effects

Some side effects may occur during the injection. Tell your caregiver right away if you feel dizzy, nauseated, light-headed, itchy or tingly, swollen, short of breath, or have a headache, fever, chills, muscle or joint pain, pain or tightness in your throat, chest pain, or trouble swallowing during the injection. Infusion reactions may also occur within 1 or 2 hours after injection.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using infliximab and call your doctor right away if you have any of these symptoms of lymphoma:

fever, night sweats, weight loss, tiredness;

feeling full after eating only a small amount;

pain in your upper stomach that may spread to your shoulder;

easy bruising or bleeding, pale skin, feeling light-headed or short of breath, rapid heart rate; or

Infliximab dosing information

Usual Adult Dose for Crohn's Disease -- Acute:

5 mg/kg given as an IV induction regimen at 0, 2, and 6 weeks followed by a maintenance regimen of 5 mg/kg IV every 8 weeks thereafter; treatment with 10 mg/kg IV may be considered for patients who respond and then lose their response

Comments:-The infusion should be administered over a period of not less than 2 hours. -For patients who respond and then lose their response, consideration may be given to treatment with 10 mg/kg IV. -Patients who do not respond by week 14 are unlikely to respond with continued dosing. Therapy should be discontinued in these patients.

5 mg/kg given as an IV induction regimen at 0, 2, and 6 weeks followed by a maintenance regimen of 5 mg/kg IV every 8 weeks thereafter; treatment with 10 mg/kg IV may be considered for patients who respond and then lose their response

Comments:-The infusion should be administered over a period of not less than 2 hours. -For patients who respond and then lose their response, consideration may be given to treatment with 10 mg/kg IV. -Patients who do not respond by week 14 are unlikely to respond with continued dosing. Therapy should be discontinued in these patients.

5 mg/kg given as an IV induction regimen at 0, 2, and 6 weeks followed by a maintenance regimen of 5 mg/kg IV every 8 weeks thereafter

Comments:-The infusion should be administered over a period of not less than 2 hours. -Patients who do not respond by week 14 are unlikely to respond with continued dosing. Therapy should be discontinued in these patients.

Use: Moderately to severely active ulcerative colitis

Usual Adult Dose for Rheumatoid Arthritis:

3 mg/kg given as an IV induction regimen at 0, 2, and 6 weeks followed by a maintenance regimen of 3 mg/kg IV every 8 weeks thereafter; adjusting the dose up to 10 mg/kg IV or treating as often as every 4 weeks may be considered for patients who have an incomplete response

Comments:-This drug should be given in combination with methotrexate.

Use: Moderately to severely active rheumatoid arthritis

Usual Adult Dose for Ankylosing Spondylitis:

5 mg/kg given as an IV induction regimen at 0, 2, and 6 weeks followed by a maintenance regimen of 5 mg/kg IV every 6 weeks thereafter

Use: Ankylosing spondylitis

Usual Adult Dose for Psoriatic Arthritis:

5 mg/kg given as an IV induction regimen at 0, 2, and 6 weeks followed by a maintenance regimen of 5 mg/kg every 8 weeks thereafter

Comments:-This drug may be administered alone or in combination with methotrexate.

Usual Adult Dose for Psoriasis:

5 mg/kg given as an IV induction regimen at 0, 2, and 6 weeks followed by a maintenance regimen of 5 mg/kg IV every 8 weeks thereafter

6 years or older: 5 mg/kg given as an IV induction regimen at 0, 2, and 6 weeks followed by a maintenance regimen of 5 mg/kg every 8 weeks

Use: Moderately to severely active Crohn's disease in pediatric patients 6 years of age and older who have had an inadequate response to conventional therapy.

Usual Pediatric Dose for Crohn's Disease -- Maintenance:

6 years or older: 5 mg/kg given as an IV induction regimen at 0, 2, and 6 weeks followed by a maintenance regimen of 5 mg/kg every 8 weeks

Use: Moderately to severely active Crohn's disease in pediatric patients 6 years of age and older who have had an inadequate response to conventional therapy.

Usual Pediatric Dose for Ulcerative Colitis:

6 years or older: 5 mg/kg given as an IV induction regimen at 0, 2, and 6 weeks followed by a maintenance regimen of 5 mg/kg every 8 weeks

Use: Moderately to severely active ulcerative colitis

What other drugs will affect infliximab?

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with infliximab, especially:

azathioprine, mercaptopurine;

methotrexate;

phototherapy for psoriasis; or

if you are also using "biologic" medications to treat your condition--adalimumab, certolizumab, etanercept, golimumab, natalizumab, rituximab, tocilizumab, and others.

This list is not complete. Other drugs may interact with infliximab, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Related treatment guides

Where can I get more information?

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.